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Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years.

Methods

The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables.

Results

A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range −4 to 4) and differential laxity also decreased (median − 4, range − 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031).

Conclusion

In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands.

Level of evidence

III.

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Acknowledgements

The authors are grateful to the ReSurg team, notably Floris van Rooij, Luca Nover and Mo Saffarini, for their assistance with statistical analyses and manuscript preparation.

Funding

This study was funded by the French Arthroscopy Society for data collection and statistical anaylsis and by Ramsay Santé for manuscript preparation.

Author information

Authors and Affiliations

  1. Lyon-Ortho-Clinic, Clinique de La Sauvegarde, Ramsay Santé, 29 Avenue des Sources, 69009, Lyon, France

    David Dejour

  2. Clinique du Sport- Centre de Consultations, 2, rue Negrevergne, 33700, Merignac, France

    Christophe de Lavigne

  3. Centre Osteoarticulaire Des Cèdres, 5 Rue des Tropiques, 38130, Grenoble, Échirolles, France

    Jean-Claude Panisset

  4. CHU de Nice, Hôpital Pasteur, 30, voie Romaine, 06001, Nice, France

    Jean-François Gonzalez

  5. CHU Lyon, Hôpital Croix Rousse, Centre Albert Trillat, 103, Grande Rue de La Croix-Rousse, 69004, Lyon, France

    Quentin Ode

  6. Hôpital de Hautepierre, Hôpital Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France

    Matthieu Ehlinger

  7. Hôpital de La Croix-Rousse, Université Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France

    Sebastien Lustig

Authors
  1. David Dejour
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  2. Christophe de Lavigne
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  3. Jean-Claude Panisset
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  4. Jean-François Gonzalez
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  5. Quentin Ode
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  7. Sebastien Lustig
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Consortia

The Francophone Arthroscopy Society

Corresponding author

Correspondence to David Dejour.

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Conflict of interest

JCP receives royalties from SBM, from BBraun Aesculap, and Xnov. DD receives royalties from SBM. JFG receives personal consulting fees from Corin and from Leo Pharma. SL receives personal consulting fees from Stryker, from Smith Nephew, from Heraeus, from Medacta, from DePuy Synthes, from Groupe Lepine, and royalties from Amplitude and from Corin. None of the author authors have any conflicts of interest.

Ethical approval

This study was approved by the institutional review board in advance (Conseil d’Orientation Scientifique Ramsay Santé, COS-RGDS-2019-12-002-DEJOUR-D).

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Dejour, D., de Lavigne, C., Panisset, JC. et al. Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years. Knee Surg Sports Traumatol Arthrosc 29, 2987–3000 (2021). https://doi.org/10.1007/s00167-020-06318-5

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